But HSJ expects the report will question whether the current tripartite leadership of departmental permanent secretary, NHS chief executive and chief medical officer is sustainable.

The problem is not the incumbents - they have found an effective way to work together. But the system lacks clarity, is confusing to outsiders and may not fare so well with different personnel.

The future of the tripartite arrangement must be debated, not least because the Conservatives are planning to introduce an independent board to run the NHS.

This could provide a more transparent structure, with a clearer distinction between political policy making and running the health service, but it could just as easily add to the confusion.

There is a real danger that politicians will be unable to wean the public off the notion that every NHS shortcoming can be resolved by ministerial meddling, rendering the board’s nominal independence worthless.

The NHS is at risk of losing significant amounts of its additional funding growth because of the time it will take to address its workforce shortages, according to a former Department of Health senior official.